Spinal analgesia, with sacral escape.

I N the ordinary type of spinal analgesia, whether induced by hypo, hyper, or isobaric solution, the result is a complete paralysis of all sensory and motor nerves from the toes right up to the segment desired. Hence in an abdominal operation, besides the abdominal area all the lumbar and sacral nerves get paralysed. It seems sometimes unnecessary that all the lumbar and sacral nerves be involved when the operation is on a part of the abdomen, and it is also undesirable, as there is often retention of urine, and so the patient is unable to pass urine and requires catheterization. Sometimes this catheterization requires to be repeated for several days as the spinal centre for micturition, situated in the sacral part of the spine, gets paralysed. This effect on the spinal micturition centre is mostly temporary, but is sometimes more pronounced by certain toxic drugs like Stovaine Anaethaine with 10 per cent glucose, heavy Nuper-caine, particularly if a bigger dose than necessary is injected and if alcohol has been used to lighten the specific gravity of the spinal solution, because alcohol has a destructive action on nerve centres and tissue, as pointed out by me in die British Medical Journal of 6th November, 1945, under Stovaine Analgesia. It is now a known fact that a few cases have occurred of permanent urinary and defecation derangements and the patients have sometimes sued or cursed the surgeon or anaesthetist concerned for their spinal anaesthetic. This is one of the reasons why certain operators prefer general to spinal anaesthesia, as they had such bitter experience of spinal anaesthesia. But the thing that prompted me to work out this method of sacral escape is that • This paper was read before the Ether Anesthesia Centenary Celebration Meeting, Bombay, October 1946.